Keywords Radiology In The 2023 Medicare Proposed Rule, QPP

Date posted: Tuesday, September 20, 2022

Category: Coding

The Centers for Medicare and Medicaid Services (CMS) press release announcing the Medicare Physician Fee Schedule (MPFS) Proposed Rule for 2023 highlights expanded access to behavioral health services, Accountable Care Organizations (ACO), cancer screening, and dental care. Of these areas, cancer screening could be important to radiology practices, but the news was not good - CMS declined to include CT colonography coverage while it expanded coverage for traditional colonoscopy. The MPFS regulates the Medicare fee schedule payment provisions as well as the Quality Payment Program (QPP).

If the overall payment adjustment in the proposed rule remains unchanged by congressional intervention, radiology will suffer cuts across the board. 

The estimated decreases do not differentiate between the global fee and the professional component. Often, revisions to things like practice expense factors affect the technical component, which is built-in to the global fee, while the professional component is not affected. A more in-depth analysis of the RVU table in an upcoming article will reveal which procedures were increased and which were decreased by more or less than the overall estimates.

In its preliminary summary, the American College of Radiology (ACR) reports that CMS accepted recommendations for 10 radiology-related CPT codes, which is a good result. 

Another bit of good news announced by CMS separate from the MPFS proposed rule is the indefinite delay of the penalty phase of the AUC/CDS program that would deny payment to radiologists when the ordering physician fails to consult a Clinical Decision Support (CDS) system to obtain Appropriate Use Criteria (AUC). It was set to begin in the year following the end of the current COVID-19 public health emergency (PHE), but the announcement by CMS states that it is unable to forecast when the payment penalty phase will begin. The current ongoing educational and testing period will continue at least beyond January 1, 2023, even if the PHE ends in 2022.

CMS has proposed to extend the telehealth flexibilities that were put into place during the PHE in order to determine if they should be made permanent. The expanded availability of telehealth includes any geographic area (not only underserved areas), any originating site setting (not limited to certain facilities, and including the patient's home), and via audio-only telecommunications systems (not requiring both audio and video). The proposal would require the appropriate Place of Service (POS) code rather than Modifier -95, and Modifier -93 would be used to indicate services furnished with audio-only technology. Under the current regulations put into place by the Consolidated Appropriations Act, 2022 the telehealth flexibilities expire 151 days after the end of the PHE.

Another PHE provision will not be extended, according to the MPFS Proposed Rule. Direct physician supervision of diagnostic exams, such as those requiring contrast administration, will no longer be allowed via real-time audio/video telecommunications. The current rule for direct supervision will expire on December 31 of the year in which the PHE ends.

The focus of the QPP has been moving away from the original MIPS and toward MIPS Value Pathways (MVP), which will first be available for reporting in 2023. In addition to the already announced pathways, CMS proposes five new MVPs and the revision of seven previously established MVPs. 

Of the new Quality Measures, one (Screening for Social Drivers of Health) could be relevant to radiology, and only one of the removed measures (#76: Prevention of Central Venous Catheter (CVC)-Related Bloodstream Infections) will affect radiology practices. We do not anticipate that the Improvement Activity changes will affect most radiology practices.

The category weighting will remain the same as it is for 2022, as will the Data Completeness Threshold of 70%. The Performance Threshold will continue to be 75 points, but the Exceptional Performance Bonus was sunset as of the 2022 performance year. The range of payment adjustment will continue to be +/- 9%.

Several QPP provisions that were previously finalized by CMS will take effect in 2023. 

The scoring changes listed above do not apply to new measures or administrative claims measures for the first two years in which they are available for use.

For performance years 2017-2022 (payment years 2019-2024), Qualified APM Participants (QP) receive a 5% APM incentive payment. The incentive payment is scheduled to be replaced by a 0.75% fee schedule increase beginning in payment year 2026; thus, there is no APM incentive payment or fee schedule adjustment for QPs in 2025 under the current regulations.

Complete information on the proposed changes to the QPP is available for download from CMS.

The proposals put forth by CMS could change in the Final Rule that is typically issued in early December for the coming year. The 4.4% cut to the fee schedule is of great concern, with the Radiology Business Management Association (RBMA) Executive Director writing that it "will do incalculable damage to the medical profession". The RBMA's Radiology Patient Action Network (RPAN) is soliciting members for a grassroots campaign to fight the cuts.

We will analyze the valuation changes proposed by CMS using the published RVU tables and continue to keep our readers apprised of the latest information. Subscribe to this blog for the latest information. 

Sandy Coffta joined HAP in 2000. In her current role as Vice President of Client Services, Sandy oversees the team responsible for achieving and maintaining the company's consistently high retention and referral rates.  

Ms. Coffta has over 17 years of experience in client relationship management, including reimbursement analysis, workflow optimization, and compliance education.  She specializes in business intelligence and reporting development, she is a subject matter expert in radiology practice billing, and she has deep expertise in resolving payer disputes and contract issues.

Ms. Coffta holds an M.A. in French Language and Literature from the State University of New York at Binghamton.